Clinical predictors of drug-resistant epilepsy in children

Abstract

Background/Aim: In up to 20% of epilepsy patients, seizures may not be controlled despite the use of antiepileptic drugs, either singly or in combination. These individuals are considered to have drug resistant epilepsy. Drug resistant epilepsy is usually associated with intellectual disability, psychiatric comorbidity, physical injury, sudden unexpected death, and low life quality. Early detection and prediction of drug resistant epilepsy is essential in determining the patient's most appropriate treatment option. This retrospective study aimed to determine the clinical, electroencephalographic, and radiological factors associated with medically intractable childhood seizures.Materials and methods: Data regarding 177 patients diagnosed with drug resistant epilepsy were compared with 281 patients with drug responsive epilepsy.Results: Univariate analysis showed that age at seizure onset, having mixed seizure types, history of status epilepticus, history of neonatal seizures, history of both having febrile and afebrile seizures, daily seizures at the onset, abnormality on the first electroencephalogram, generalized epileptic abnormality on electroencephalogram, abnormal neurodevelopmental status, abnormal neuroimaging, having symptomatic etiology were significant risk factors for the development of drug resistant epilepsy (P < 0.05). In multivariable analysis, having mixed seizure types, history of status epilepticus, having multiple seizures in a day, intellectual disability, symptomatic etiology, and neuroimaging abnormality remained significant predictors for developing drug resistant epilepsy. Conclusions:In the course of childhood epilepsy, some clinical features may predict the outcome. Early identification of patients with high risk for drug resistant epilepsy will 2 help plan the appropriate treatment option. Further prospective studies should confirm these findings.

Risk factors for Drug‐resistant Epilepsy (DRE) and a nomogram model to predict DRE development in post‐traumatic epilepsy patients

“…We found abnormal findings of interictal EEG monitoring were associated with DRE among PTE patients, especially the presence of epileptiform discharges. Previous studies also reported that focal epileptiform activity, 42 focal slowing, asymmetric spike–wave discharges, 42 and EEG with generalized epileptiform activity (primarily poly‐spikes) 31 were poor prognostic factors for epilepsy. Therefore, we believe that EEG monitoring, even routine interval EEG monitoring, is of great value in assessing the outcome of PTE.…”

“…According to a meta-analysis published by Kalilani et al 42 and EEG with generalized epileptiform activity (primarily poly-spikes) 31 were poor prognostic factors for epilepsy.…”

“…As one of the most common and severe complication of TBI, PTE leads to significant psychosocial and economic burden, psychiatric comorbidity, physical damage, low quality of life, and sudden unexpected death of the patients, 11,28 especially for those that are progressing to DRE. 29,30 In an era when everyone is paying more attention to the quality of life, patients and physicians would ben- Over the years, there have been many published literatures, 16,22,31 which have carried out in-depth exploration on the incidence, risk factors, and outcomes of DRE. However, DRE caused by a specific etiology (such as TBI) may not have been explored.…”

“…Over the years, there have been many published literatures, 16,22,31 which have carried out in‐depth exploration on the incidence, risk factors, and outcomes of DRE. However, DRE caused by a specific etiology (such as TBI) may not have been explored.…”

Clinical, radiological and electrophysiological predictors for drug-resistant epilepsy

“…Yilmaz and colleagues [ 30 ] reported that Patients with drug-resistant epilepsy are more likely to experience mixed seizures than drug-responsive patients, who are more likely to experience generalized seizures. Similarly, a retrospective study showed that mixed seizure is an independent risk factor for drug-resistant epilepsy in childhood [ 31 ]. Chawla and colleagues [ 32 ] discovered that generalized tonic seizure was the most prevalent type in the drug-resistant epilepsy group.…”